TÉCNICAS PARA LA INSERCIÓN DE SONDA GASTROINTESTINAL EN PACIENTES CRÍTICOS: REVISIÓN DEL ALCANCE

Queiroz, Cintia Galvão; Duarte, Fernando Hiago da Silva; Sarmento, Sabrina Daiane Gurgel; Dantas, Joyce Karolayne dos Santos; Dantas, Daniele Vieira; Dantas, Rodrigo Assis Neves

doi:10.1590/1980-265X-TCE-2021-0017

person Cintia Galvão Queiroz

schoolUniversidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

0000-0003-4680-4373

person Fernando Hiago da Silva Duarte

schoolUniversidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

0000-0002-2743-0452

person Sabrina Daiane Gurgel Sarmento

schoolUniversidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

0000-0002-5999-0139

person Joyce Karolayne dos Santos Dantas

schoolUniversidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brasil.

0000-0002-5259-8556

person Daniele Vieira Dantas

schoolUniversidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

0000-0003-0307-2424

person Rodrigo Assis Neves Dantas

schoolUniversidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil.

0000-0002-9309-2092

groupsCONTRIBUTION OF AUTHORITY

Study design: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Data collection: Queiroz CG, Dantas JKS. Data analysis and interpretation: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS. Discussion of results: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Writing and/or critical review of the content: Queiroz CG, Duarte FHS, Sarmento SDG, Dantas JKS, Dantas DV, Dantas RAN. Review and final approval of the final version: Dantas DV, Dantas RAN.

CONFLICT OF INTEREST

There is no conflict of interest.

EDITORS

Associated Editors: Mara Ambrosina de Oliveira Vargas, Gisele Cristina Manfrini, Ana Izabel Jatobá de Souza. Editor-in-chief: Roberta Costa.

CORRESPONDING AUTHOR

Cintia Galvão Queiroz cintia.queiroz@yahoo.com.br

PCC	MESH/DeCS			Keywords (Ing/En)
*Population*	Coma/Coma		OR	Critical patients/ Pacientes críticos OR Comatose
	*AND*
*Concept*		Intubation, Gastrointestinal/ OR Intubação gastrointestinal		Intubation, Nasogastric/ Intubação nasogástrica OR Gastrointestinal intubation/ Gastrointestinal intubation
	AND
*Context*	Critical Care		OR	Intensive Care / Intensive Care OR Care, Intensive Surgical / Intensive Care Cirúrgica *OR Care,* Intensive / Intensive CareOR Surgical Intensive Care

Data sources	Search syntax
Pubmed*	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
CINAHL†	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Scopus‡	TITLE-ABS-KEY (“Coma” OR “Comatose” OR "Critical patients") AND TITLE-ABS-KEY ("Intubation, Gastrointestinal" OR "Intubation, Nasogastric" OR “Gastrointestinal intubation”) AND TITLE-ABS-KEY ("Critical Care” OR “Intensive Care” OR “Care, Intensive Surgical” OR “Care, Intensive” OR “Surgical Intensive Care”).
Web of Science§	TS= (Coma OR Comatose OR Critical patients) AND TS= (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND TS= (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Cochrane\|\|	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
ScienceDirect¶	(Coma OR Comatose) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care).
Gale**	(Coma OR Comatose OR Critical patients) AND (Intubation, Gastrointestinal OR Intubation, Nasogastric OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Care, Intensive Surgical OR Care, Intensive OR Surgical Intensive Care).
Catalogue of Theses and Dissertations††	(Coma OR Comatoso OR Critically Ill Patients) AND (Gastrointestinal intubation OR Nasogastric intubation OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care OR Intensive Care OR Intensive Care OR Intensive Surgical Care).
Usp‡‡ Digital Library of Theses and Dissertations	(Coma or comatose) AND (Gastrointestinal intubation OR Nasogastric Intubation OR Gastrointestinal Intubation) AND (Critical Care OR Intensive Care OR Intensive Surgical Care).
Google Academic§	(Coma OR Comatose OR Critically Ill Patients) AND (Gastrointestinal intubation OR Nasogastric intubation OR Gastrointestinal intubation) AND (Critical Care OR Intensive Care OR Surgical Intensive Care OR Intensive Care OR Intensive Care OR Intensive Surgical Care).

Study Year/Location	Type of study/Level of evidence/Degree of recommendation	Study population
E1 2020 - USA¹⁷	Cohort study /2B/B	601 patients undergoing induced coma.
E2 2020 - Belgium¹⁸	Cohort study /2B/B	218 critically ill ICU patients.
E3 2020 - Iran¹⁹	Randomized clinical trial /1B/A	396 critically ill patients.
E4 2018 - India²⁰	Randomized clinical trial /1B/A	195 anesthetized and intubated adult patients undergoing abdominal surgeries.
E5 2017 - Turkey²¹	Randomized clinical tria l/1B/A	200 adult patients who received general anesthesia for elective abdominal surgeries.
E6 2017 - Italy²²	Cohort study /2B/B	114 patients in critical condition, 100 mechanically intubated and two tracheostomized.
E7 2016 - Malaysia²³	Randomized clinical trial /1B/A	96 anesthetized and intubated adult patients scheduled for surgery.
E8 2016 - Japan²⁴	Case report /5/D	84-year-old patient in physiological coma.
E9 2015 - Netherlands²⁵	Randomized clinical trial /1B/A	154 patients in surgical patients (sedated).
E10 2015 - Turkey²⁶	Cohort study /2B/B	56 patients using mechanical ventilation hospitalized in ICU.
E11 2015 - China²⁷	Randomized clinical trial /1B/A	156 critically ill patients with acute gastrointestinal injury admitted to the ICU.
E12 2013 - India²⁸	Case report /5/D	one patient in physiological coma.
E13 2013 - Taiwan²⁹	Randomized clinical trial /1B/A	150 anesthetized and intubated adult patients undergoing gastrointestinal surgeries.
E14 2012 - Taiwan³⁰	Randomized clinical trial /1B/A	103 anesthetized and intubated adult patients undergoing gastrointestinal or hepatic surgeries.
E15 2011 - USA³¹	Randomized clinical trial /1B/A	Critically ill patients who do not tolerate intragastric nutrition.
E16 2011 - USA³²	Randomized clinical trial /1B/A	49 critically ill children admitted to ICU.
E17 2011 - Germany³³	Cohort study /2B/B	27 critically ill patients undergoing trans nasal endoscopy and pylorus intubation.
E18 2010 - China³⁴	Randomized clinical trial /1B/A	50 children admitted to pediatric ICU.
E19 2010 - Netherlands³⁵	Randomized clinical trial /1B/A	210 critically ill patients.
E20 2005 - USA³⁶	Randomized clinical trial /1B/A	14 patients admitted to neurosurgical ICU, with Glasgow score less than 8 (mean of 6.8 ± 0.36).
E21 2005 - USA³⁷	Randomized clinical tria l/1B/A	100 untestable ICU patients.
E22 2005 - USA³⁸	Randomized clinical trial /1B/A	75 critical pediatric patients admitted to the ICU.
E23 2004 - USA³⁹	Randomized clinical trial /1B/A	43 critically ill ICU patients.
E24 2000 - USA⁴⁰	Randomized clinical trial /1B/A	30 severely ill patients tracheostomized or with endotracheal tube.
E25 2000 - USA⁴¹	Randomized clinical trial /1B/A	50 children admitted to pediatric ICU.

Study Year/Local	Tubing technique	Denouement
E17 2011 - Germany³³	Insertion of the tube under radiological or endoscopic guidance.	Early placement of a feeding tube during abdominal surgery was beneficial in trauma patients with severe intracranial injury.
E18 2010 - China³⁴	"Blind" insertion and patient in semi-fowler position; application of corrected formula to measure how far the tube will be inserted.	The corrected formula of the nose-lobe distance of the ear-xiphoid process as a precise method to determine the insertion length of the nasogastric tube.
E19 2010 - Netherlands³⁵	The SORT maneuver (patient positioning, NGT orientation, contralateral rotation and torsional movement) versus neck flexion lateral pressure method (NFLP).	The SORT maneuver has a high success rate. Therefore, this method can be executed, but there is still no consensus on a standard approach.
E20 2005 - USA³⁶	Conventional technique, tube freezing and reverse Sellick´s maneuver.	Nasogastric tube insertion using reverse Sellick´s maneuver shows the highest success rate and fewer adverse events among the three methods compared in anesthetized and intubated adult patients.
E5 2017 - Turkey²¹	"Blind" insertion, laterally positioned head, tracheal tube assistance as an introducer "guide" and video laryngoscope aid in anesthetized and intubated adult patients.	The use of video laryngoscope and tracheal tube during tube insertion compared to conventional ones increased the success rate and reduced tube folding, in addition to reducing mucosal bleeding.
E6 2017 - Italy²²	Tip measurement of the ear-lobe tip-xiphoid process/Ultrasound examination.	Ultrasound is effective in verifying the correct positioning of the tube.
E7 2016 - Malaysia²³	GlideScope-guided laryngoscope ® MacIntosh laryngoscope.	The use of GlideScope® to facilitate nasogastric tube insertion was comparable to Macintosh laryngoscope use for insertion success rate and complications.
E8 2016 - Japan²⁴	Fluoroscopy.	The insertion of the fluoroscopy tube was successful in gastric decompression, assisting in nutrition until the preparation of a percutaneous endoscopic gastrostomy.
E9 2015 - Netherlands²⁵	Patient in supine position. Insertion of post-pyloric feeding tube via electromagnetic transmitter and endoscopy in surgical patients.	Effective techniques for insertion of nasoenteral feeding tube. More scientific studies are needed to strengthen the evidence.
E10 2015 - Turkey²⁶	Ultrasound examination/head in supine position.	The passage of the tube with the aid of this method can be used as an adjuvant.
E11 2015 - China²⁷	Placement of nasojejunal tube guided by ultrasound at the bedside versus "blind" insertion at the bedside.	Placement of the ultrasound-guided jejunal nasal tube is better than the blind method.
E12 2013 - India²⁸	"Blind" insertion with neck flexion, identification of cricoid cartilage (all 20 cm inserted), and insertion of approximately 50 cm of nasogastric tube.	Easy and useful technique for insertion in unconscious intubated patients. It does not alter vital responses or increase intracranial pressure as in laryngoscopy.
E13 2013 - Taiwan²⁹	Conventional insertion, neck flexion with lateral pressure and cricoid cartilage lifting.	Neck flexion with lateral pressure and cricoid cartilage lifting are reliable for inserting the tube without the use of other instruments.
E14 2012 - Taiwan³⁰	Insertion of the tube with the head in the supine position versus insertion with the aid of a "Rusch" intubation stylus tied at the ends by a knot.	The "Rusch" stiletto-guided method of intubation is reliable, with a high success rate in anesthetized and intubated patients.
E15 2011 - USA³¹	Insertion of a jejunal feeding tube electromagnetically or endoscopically.	The placement of the tube electromagnetically was as fast, safe and successful as the endoscopic tube.
E16 2011 - USA³²	Insertion of transpypiloric feeding tube using conventional blind technique with the help of a noninvasive electromagnetic device.	Insertion by non-invasive electromagnetic device significantly increases the time required for placement.
E17 2011 - Germany³³	Insertion of feeding tube by transnasal endoscopy.	The procedure is safe and reliable, having a good success rate. Complications such as bleeding are rare.
E18 2010 - China³⁴	Patients in supine position. Insertion by optical endoscope fiber. Concomitantly, an electromagnetic technology is used. The image is displayed as the tube is inserted.	Bedside electromagnetic-guided placement is as fast, safe, and successful as endoscopic placement. It may be considered the preferred technique in critically ill patients.
E19 2010 - Netherlands³⁵	Patient in supine position. The stylus is inserted inside the tube and allows the visualization of its position and path traveled.	The procedure was considered feasible and safe and can be used in critically ill patients.
E20 2005 - USA³⁶	Blind procedure. Position without reclining, with the head slightly tilted back.	The specifically designed nasojejunal tube showed greater efficacy in transpyloric placement after the Treitz ligament, when compared to the nasogastric tube in patients with severe head trauma.
E21 2005 - USA³⁷	Endoscopic insertion of NES with a 5.1 mm ultra-thin tube endoscope and by fluoroscopic technique.	The success of placing NES with an ultrathin transnasal endoscope is equivalent to fluoroscopy.
E22 2005 - USA³⁸	Standard technique, standard technique with gastric insufflation and standard technique with the use of pre-insertion erythromycin.	Most feeding tubes can be placed in critically ill children on the first or second attempt, regardless of the technique used.
E23 2004 - USA³⁹	Endoscopic vs. fluoroscopic placement of post-pyloric feeding tubes in critically ill patients.	There is no significant difference in relation to the success rate or time of placement via endoscope and fluoroscopic of post-pyloric feeding tubes.
E24 2000 - USA⁴⁰	Patients were randomized in group A (fluoroscopy) or group B (blind insertion).	Intubated or tracheostomized patients should place feeding nasoenteric tubes with fluoroscopy guidance.
E25 2000 - USA⁴¹	Gastric insufflation as a complement to the placement of feeding tubes in the small intestine. And insertion through the nostrils without the aid of adjuvant method.	Gastric insufflation allows the rapid placement of feeding tubes in the small intestine with fewer attempts, compared to a standard insertion technique in children.

[TFN1] *PubMed Central; †Medical Literature Analysis and Retrieval System Online; ‡Elsevier's SCOPUS; §Web of Science; || Cochrane Library; ¶ScienceDirect; **Gale Academic Onefile; ††Catalogue of Theses and Dissertations (CAPES); ‡‡Digital Library of Theses and Dissertations of the University of São Paulo; §§Google Academic.